Provider Demographics
NPI:1225313521
Name:RICE, SHANNA MICHELLE (MHR)
Entity Type:Individual
Prefix:MISS
First Name:SHANNA
Middle Name:MICHELLE
Last Name:RICE
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 ALLI CIR
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-7331
Mailing Address - Country:US
Mailing Address - Phone:405-320-0050
Mailing Address - Fax:
Practice Address - Street 1:198 EAST ALMAR DRIVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018
Practice Address - Country:US
Practice Address - Phone:405-222-5437
Practice Address - Fax:405-222-5452
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1252101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)